Excerpted from page 28 of the July/August 2018 edition of AOA Focus.
Ask 10 doctors of optometry about their hiring practices, and you might hear 10 different approaches. Yet, they would probably all agree on one thing: Hiring a trustworthy, professional staff is essential for any small business, including optometric practices. A good staff member can help bring in and retain patients.
Bad hires can be bad news. They can create havoc among their colleagues or even embezzle your funds.
"Bad hires happen," says Keith Kerns, Esq., executive director of the Ohio Optometric Association, who frequently presents to health care providers on hiring.
There's a price to pay for hires who don't work out, says Lisa Wade, O.D., director of the Hayes Center for Practice Excellence at Southern College of Optometry in Memphis, Tennessee. The Hayes Center's mission is "to teach independent optometrists the fundamentals of managing the business side of their practice, including strategic planning, budgeting, overhead control and profitability."
Direct costs of failed hires include recruitment and advertisement expenses, as well as time spent interviewing, testing and training a new employee, Dr. Wade says.
Indirect costs? There can be a loss of institutional knowledge and productivity until you can fill the position.
"Making a plan and taking the time to hire well is the best opportunity to avoid all types of negative impacts of a bad hire," Dr. Wade says. "Have a good plan to hire before you even advertise. Know what you need, what success will look like in the position and what you have to pay for a quality candidate."
AOA Focus asked Kerns, Dr. Wade and others for tips that could improve the hiring process for doctors of optometry.
Write down your hiring policies and document your training
"To protect the practice from claims of harassment or maintaining a hostile work environment, offices should adopt a 'zero tolerance' policy against all forms of harassing conduct and provide training to staff members on the topic on a periodic basis," Kerns says. "The policy should have a 'duty to report' the conduct in question, outline a complaint procedure and let employees know that there will be no retaliation for bringing the conduct to light. Harassing conduct can occur not only between employees but also can come from patients, vendors and others. And an employer has an obligation to take action if they receive a complaint of this nature. Failing to do so could expose the doctor or practice to liability.
If you don't have an employee manual, get one now. And, if you haven't reviewed your manual in several years, now is the time. The manual is the best tool an employer can have, and the great thing about it is you can change it at any time." Have your legal counsel review the employee manual periodically, as laws and regulations are subject to change.
Background checks (criminal and credit histories) are a good idea
Dr. Wade says both are appropriate, but doctors should know the laws in their state, county or municipality, including "ban the box" laws or policies. The ban-the-box movement is aimed at removing questions about past convictions from initial job applications. According to the National Employment Law Project, about 150 cities and counties have adopted these policies. The laws/policies can apply to either public or private employers or both.
"Time and distance from the crime is relevant, and type and nature of work they would do for you matter," she says. "You can't make a blanket statement that you don't hire anyone convicted of a crime." When credit checks can be done, they must comply with the Fair Credit Reporting Act, she says. Some states even may restrict the use of a credit check in the hiring process.
"A clean drug test—post offer—can be a condition of employment," Dr. Wade says. She and Kerns both note new state laws legalizing marijuana. Even in states where the drug is legal, employers may still be able to require a marijuana-free drug test. It's best to have legal counsel involved on this issue; a qualified attorney will be able to cross-check your company's drug-testing policy against state and federal laws to ensure it's compliant on all levels. Instances in which a potential employee uses marijuana to treat a medical condition can become especially tricky.
Trust, but verify
Among checks that can uncover pertinent information about a potential employee, Dr. Wade recommends identity verification, criminal history, past litigation, education records, workman's compensation records and employment history. "References can yield vital information about a candidate," she says. "Relevant external observers are in a better position to give you an accurate estimate of whether the candidate will be able to perform with regard to the specific circumstances and challenges in your practice." Keep in mind that some of these checks—such as criminal history (see tip No. 2) and workers' compensation—can be tricky. Have your legal counsel provide more guidance to ensure your verification process is in accordance with law.
Be careful with 'tryouts' and 'working interviews'
"A 'tryout' or 'working interview' is popular in many offices, and you can learn a lot from an individual as a potential employee," Kerns says. "But doctors should proceed with caution. There have been rare instances where an applicant has participated in a 'tryout' and ultimately not been offered the job, and then filed for unemployment. Doctors can protect against this by taking a few easy steps:
- Don't call it a working interview. Use the term 'skills assessment' or something similar. Avoid language that gives the applicant the idea that they are actually working at the office.
- Limit the amount of time of the skills assessment; don't have the applicant cover an entire day.
- Don't have the applicant fill in for an absent employee.
- Consider having the applicant sign an agreement acknowledging that there is no employment relationship established.
According to the IRS and Department of Labor, an individual performing work for your business must be classified as either an employee or independent contractor—and they must be compensated for their time. As long as the potential hire is not performing work for your practice, and the practice will receive no financial benefit from it, a skills test is simply part of the interview process to evaluate knowledge, skills and abilities—and more importantly, is within the boundaries of law.
Are they a fit?
"Once you determine a candidate is a positional fit, you need to determine if they are a cultural fit," says Dr. Wade, noting that this can be determined through carefully worded behavioral questions for an interview. There also are tests for determining cultural fit, she says.
Adds Kerns: "The best advice for the interview process is to try to get the applicant talking. Many employers spend too much time talking about their business and how the office operates. Ask open-ended questions and try to get the applicant to expand on answers. And always remember to keep the questions focused on the applicant's ability to perform the duties associated with the position, not on personal issues."
After the hire
"Having a stated, enforced 90-day probationary period of employment for every hire is critical," says Dr. Wade, who also suggested "meaningful" evaluations at 10, 40 and 70 days. "This is probably the single biggest failure of employers—they think they can 'fix' an employee and can't stand the idea of having to go through the hiring process again, so they keep people who ultimately become a 'bad hire."
Dr. Wade recommends that doctors consider purchasing policies, including employment practices liability insurance, a business owner's policy and employee dishonesty coverage. "These days, they probably should consider cyberliability, too," Dr. Wade says.
AOAExcel®'s professional liability insurance partner, Lockton Affinity, is now offering Employment Practices Liability (EPL) Insurance to AOA members. EPL helps employers respond to allegations of harassment, discrimination, improper hiring practices and employment-related incidents. For additional information about Employment Practices Liability, call Lockton Affinity's AOA customer service line at 888.343.1998.
Review your processes for handling money
Sometimes not even a background check will turn up criminal history, says Kerns, noting that "most" employee theft goes unreported. Take precautions, they say. Kerns advises doctors of optometry "to have copies of cancelled checks and bank statements mailed directly to the doctor (let your employees know you are doing that, too), personally sign all checks over a certain amount, don't write checks to acronyms and hire a certified public accountant to review your finances on a regular basis."
Dr. Wade adds, "Small practices are challenged, but at the very least, they should set up an operation in which one person controls what comes in (cash, checks, merchandise, supplies) and another person handles what goes out (payments, orders, finished products). Someone other than the bookkeeper should reconcile bank and credit card statements every month and the person who reconciles the bank statements should not have the ability to enter or modify transactions in the accounting system. A doctor who doesn't routinely review financials is a danger to himself or herself. Know your business.
Be a competitive employer
"A very tight labor market will require creativity," Dr. Wade says. "Always be recruiting. Hand out business cards to anyone anywhere who provides you with great customer service."
Zero toleration for unlawful activity in the practice
Lisa Heuer, O.D., who practices in Woodland, California, knows firsthand the disappointment and disheartenment of a hire gone bad. Dr. Heuer discovered in 2013 that an employee had stolen money and materials from her practice. She had inherited the employee when she took over the practice a couple of years earlier.
What did she learn from the experience?
First, she says, trust but verify. "Don't let a theft episode make you paranoid or change who you are at the core," Dr. Heuer says. Second, she says, report the theft to authorities. "Your initial inclination may be to forget about the incident and move on because there are a million more pressing things to address, but resist that urge. It's important that there be consequences for the thief and that you demonstrate to others that you will not tolerate unlawful activity in your practice. Involving the authorities may decrease the odds that other local colleagues and business owners suffer a similar fate. Can the process be time-consuming and stressful? Yes, of course, but it's usually worthwhile for the greater good.
"In hindsight, I don't have any regrets about how I handled the aftermath of the theft," says Dr. Heuer, who also was able to gain closure while her practice regained its solid footing.
The AOA will use the time to evaluate its collection efforts and create a registry for the future that is most useful to improving eye health and vision care. The AOA launched the registry in 2015.
Even if you’re choosing to disengage, today’s politics have a way of finding you. What are the ground rules for approaching political debates in the practice?
Under new rules for the 21st Century Cures Act, doctors of optometry will need to prepare for changes going into effect April 5. Doctors should check in with their health IT vendor in order to make sure they meet the new requirements.